Sensory Examination Flashcards by Jean P

Examined in peripheral sensory examination

Spinal cord/nerve (peripheral nerve)
Tactile (touch, pain, temp)
Vibration
Position

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Examined in cortical sensory examination

Somatosensory cortex
discriminative senses
- stereognosis
- graphesthesia
- 2 point discrimination

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Assessment for light touch sensation

Use wisp of cotton

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Abnormal finding to touch: absent sensation

Anesthesia

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Abnormal finding to touch: decreased sensation

Hypoesthesia

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Abnormal finding of touch: increased sensation

Hyperesthesia

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Assessment for pain sensation

Test with pinprick

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Abnormalities to pain: absent sensation

Analgesia

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Abnormalities to pain: decreased sensation

Hypoalgesia

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Abnormalities to pain: increased sensation

Hyperalgesia

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Assessment for Temperature

Test tubes, hot and cold water

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Tested only when pain sensation is abnormal

Temperature

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Assessment for Vibration sense

Use of tuning fork (128Hz)

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Dorsal column testing

Propioception

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First sensation lost in peripheral neuropathy, diabetic nephropathy, and Buerger’s dse

Vibration

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Lesion/disease in where: loss of vibration sense

Posterior column

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Identification of an object by touch or feel

Stereognosis

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Inability to recognize familiar objects by touch or feel

Astereognosis

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Only one hand cannot recognize familiar objects by touch or feel

Tactile agnosia

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Number/Letter identification

Graphesthesia

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2pt. Discrimination: Object placed >5mm distance

Double stimuli

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2pt. Discrimination: Object placed <5mm distance

Single stimulus

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Sensory examination not done in children 6 years old and younger

Cortical sensory examinations

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Contralateral loss of 2 pt discrimination, astereognosis, sensory inattention and agraphesthesia

Cortical sensory loss

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Able to recognize all sensations but localize them poorly; parietal lobe lesions

Cortical sensory loss

Loss of 2pt. discrimination, astereognosis, agraphesthesia, sensory inattention on RIGHT side of patient’s body

LEFT Parietal brain abscess

Inability to process sensory information

Agnosia

Loss of ability to recognize a single modality (usually hearing and vision) with no significant memory loss

Agnosia

Where is the damage in Agnosia?

Occipitotemporal border

Where is the damage in Astereognosis?

Somatosensory cortex (Parietal)

A psychiatric problem; deficit of self-awareness; unaware of existence of diability

Anosognosia

Damage to what brain structures in Anosognosia? (2)

Parietal lobe | Frontotemporoparietal area of right hemisphere

Single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment

Anosognosia

Sensory loss based on the distribution of a single nerve supply

Single nerve loss

Peripheral Neuropathy Glove and Stocking sensory loss Commonly seen in diabetic neuropathy

Distal peripheral nerve loss

Spinal cord syndrome: affecting part of the trunk, pelvic region and the legs; results from injuries LOWER on the spine

Paraplegia

Spinal cord syndrome: affects trunk, arms, legs, hands and pelvic region; results from injuries HIGHER on the spine

Quadriplegia (tetraplegia)

Spinal cord injury: complete loss of motor and sensory function BELOW the spinal cord injury

Complete spinal cord injury

C4 and C6 injury

Quadriplegia

T6 and L1 injury

Paraplegia

Spinal cord injury: BELOW injury level, motor PARALYSIS, loss of PAIN and TEMPERATURE sensation

Anterior Cord Syndrome

Spinal cord injury: BELOW injury level, motor WEAKNESS or PARALYSIS on ONE side of the body (hemiparaplegia); loss of sensation on OPPOSITE side (hemianesthesia)

Brown-Sequard Syndrome | Lateral Hemisection

Spinal cord injury: BELOW injury level, motor function PRESERVED, loss of SENSORY function (pressure, stretch, propioception)

Posterior Cord Syndrome

Spinal cord injury: results from cervical spine injuries; greater motor impairment of upper body

Central Cord Syndrome

ASIA SCI Impairment Grade: complete; no motor or sensory function preserved

Grade A

ASIA SCI Impairment grade: incomplete; sensory but no motor function preserved below the neurologic level (S4-5)

Grade B

ASIA SCI Impairment grade: incomplete motor; >50% of key muscles below the neurologic level have muscle strength grade <3

Grade C

ASIA SCI Impairment grade: incomplete motor; >50% of key muscles below the neurologic level have a muscle strength grade equal to or >3

Grade D

ASIA SCI impairment grade: normal

Grade E

Spinal cord ends at the spinal level L1,L2 as _____

Conus medullaris/terminalis

Bundle of spinal nerves

Cauda equina (horse tail)

Lumbar enlargement

L2-L5

Sacral enlargement

S1-S5

Higher medullary cone

Conus medullaris syndrome

Lower medullary cone

Cauda equina syndrome

Injury to the terminal spinal cord | Early incontinence, perineal numbness and preserved knee reflex

Conus Medullaris Syndrome

Injury to the lumbosacral nerve roots in the spinal canal; asymmetric lower limb weakness, leg pain, numbness absent reflexes, delayed incontinence

Cauda Equina Syndrome

Exit of nerve roots in the cervical region

Exit ABOVE

Exit of spinal nerve roots in thoracic and lumbar regions

Exit BELOW

C7 nerve root exists (ABOVE or BELOW) C7 vertebral body

Above, through C6-C7 neural foramen

C8 nerve root exits between ____

C7 and T1; no C8 vertebral body

L3 nerve root exits (ABOVE or BELOW) L3 vertebral body

Below, through L3-L4 foramen

Damage in _____ results in loss of pain/light touch and temperature on IPSILATERAL face and CONTRALATERAL side of the body

Brainstem damage

Damage in _____ results in CONTRALATERAL hemisensory loss of all movements

Thalamic damage

Loss of pain and temperature on the left side of the face and on contralateral side of the body

Left Brainstem Hemorrhage

Loss of all modalities of sensation on the left side of face and body

Right Thalamic Hemorrhage

Loss of two point discrimination, stereognosis, agraphesthesia and sensory inattention on right side

Left Parietal Brain Abscess

Classification of pain: represents the normal response to noxious insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons or bones

Nociceptive pain

Classification of pain: pain initiated or caused by a primary lesion or disease in the somatosensory nervous system

Neuropathic pain

Classification of pain: a result of activation and sensitization of the nociceptive pain pathway by a variety of mediators released at site of tissue inflammation

Inflammatory Pain

Pain intensity: <4

Mild

Pain intensity: >7

Severe

Pain of less than 3 to 6 months duration

Acute pain

Pain lasting for more than 3-6 months or persisting beyond the course of an acute disease, or after tissue healing is complete

Chronic pain

Acute pain flare superimposed on underlying chronic pain

Acute-on-chronic pain